The Impact of COVID-19 on African Americans

This content originally appeared on Beyond Type 1. Republished with permission.

By T’ara Smith

Think the coronavirus is the “great equalizer”? Think again. New data on the deaths from coronavirus shows the pandemic is impacting communities of color, specifically African-Americans, at disproportionate rates. African-Americans and other minorities are more likely to have underlying conditions such as diabetes, hypertension, heart disease, and asthma, which contribute to the mortality rate of COVID-19. These underlying conditions stem from health inequalities that range from food accessibility to barriers to healthcare.

African American

Image source: Beyond Type 1

Compared to non-Hispanic whites, Black/African-Americans are 60 percent more likely to have diabetes according to the Office of Minority Health. However, this doesn’t mean minorities are more susceptible to being infected by COVID-19, but that when they are infected they are more likely to die from it.

“It’s not that they’re getting infected more often. It’s that when they do get infected, their underlying medical conditions wind them up in the ICU and ultimately give them a higher death rate. We really do need to address the health disparities that exist in the U.S,” said Dr. Anthony Fauci, National Institute of Allergy and Infectious Disease (NIAID) director and leading expert on the coronavirus pandemic, at a White House briefing on Tuesday.

Recent data reported from cities and states magnifies how dire the pandemic situation has become for African-Americans. In Michigan, African-Americans made up 35 percent of COVID-19 cases and 41 percent of deaths — African-Americans consist of 14 percent of Michigan’s population. Specifically, Detroit, a city with predominantly Black residents, is a hot spot for coronavirus cases. In Chicago, 72 percent of COVID-19-related deaths were Black, who only make up 29 percent of the city’s population. Louisiana has shown a trend nearly identical to Chicago’s.

Evidence shows African-Americans are also having more difficulty getting tested for coronavirus. In early April, Syracuse University reported that while COVID-19 testing is far too low in the United States in general, the testing rates are lower in states with higher percent black populations and poverty rates.

Coronavirus Further Exposes Long-Existing Health and Economic Disparities

The prevalence of chronic health conditions in minorities such as diabetes can be attributed to long-existing barriers to quality of life essentials such as food, health care, and sustainable income. Food deserts, or areas where there is no access to food or quality healthy food, are more abundant in minority neighborhoods. African-Americans are more likely to be uninsured, rely on government insurance, and are less likely to have private insurance compared to their white counterparts, according to the Office of Minority Health. They’re also more likely to have a lower median income. Recent data also shows the wave of millions of job losses is disproportionately affecting minorities.

“It’s jarring to me to hear that African-Americans are disproportionately affected by COVID-19,” said Mila Clarke Buckley, Beyond Type 2 Leadership Council member and owner of the Houston-based Hangry Woman website, who has been living with type 2 diabetes since 2016. “We do have to recognize the systemic factors that play a role in this. Even though I have privilege and resources, I don’t feel safe. It has highlighted the importance to me of practicing social distancing, and staying in as much as possible. I don’t want to be in a position where I can’t get the care I need if I were to get the virus.”

Current CDC recommendations to decrease the risks of contracting coronavirus are to stay home and practice social distancing. However, not everyone has the privilege to abide by those guidelines. A report by the Economic Policy Institute based on federal labor data shows Black and Hispanic workers are less likely to be able to work from home.

“Taking public transportation to get to jobs as essential workers because they can’t afford to not work, living in food deserts and having to travel to get groceries, and other issues that have been reported on,” said Dr. Fauci at a press conference.

Constance Brown-Riggs, MsEd, RD, DCES, CDN, discussed another layer to the public health crisis’ impact on minorities: the lack of trust in the healthcare system itself.

African American

Image source: Beyond Type 1

“There are many factors that contribute to health disparities in people of color. One factor is the mistrust of the medical community. Additionally, numerous studies show that health care provider bias also contributes to health care disparities,” said Brown-Riggs. A New York Times article published in January summarized the generations of institutional racism and discrimination towards African-Americans.

“One of the most troubling explanations for mistrust is the Tuskegee experiment, in which poor black men were unknowingly infected with syphilis and allowed to live with the deadly infection so doctors could track the life history of the disease. Black Americans who know of the study report a greater mistrust of medicine and research,” said Brown-Riggs.

Global patient diabetes advocate of Black Diabetic Info and Beyond Type 2 Leadership Council member, Phyllisa Deroze, also echoes a similar sentiment about bias within the healthcare system.

“I’m not surprised that African-Americans are impacted more,” said Deroze, who lives with LADA diabetes. “I have long since said that the coronavirus might not discriminate, but the American Healthcare system has a long history of being biased. Just look at the maternal mortality rate – black women are 3-4 times more likely to die than white women [in childbirth].”

African-Americans and other minorities have also reported experiencing racial discrimination at medical appointments. Among professionals who work with minorities with diabetes, Brown-Riggs says the lack of diversity plays is a factor as well.

Studies show that most health care providers have an implicit bias in terms of positive attitudes toward whites and negative attitudes toward people of color,” says Brown-Riggs. “This bias is particularly worrisome when the majority of people with type 2 diabetes are African American or Hispanic American and the majority of diabetes care and education specialists and nutrition professionals are white.”

Pressing Forward Despite Systemic Barriers

African American

Image source: Beyond Type 1

Still, African-Americans and other minorities with diabetes are taking the steps to lower their risks of getting the novel coronavirus. Paul Ellis, a person with type 2 diabetes living in Cerritos, California, says despite the issues within the healthcare system, he’s going to do what’s necessary to decrease his chances of contracting it. “I try not to let [the health disparities] get to me,” said Ellis. “I’m determined to manage the disease the best I can and have made a lot of progress since I was diagnosed. I lost a lot of weight, and between that, exercise, diet, and meds, I am doing pretty well. I even did a virtual 5k for the first time a couple of weekends ago and even though I was as slow as molasses, I did it to show myself I won’t be beaten.”

Likewise, Deroze is not taking any chances with COVID-19 and says she’s taking the guidelines seriously. However, the stress and anxiety from the COVID-19 have impacted her glucose levels.

“I’m staying indoors and am only leaving the house for an hour walk in the morning,” said Deroze. “After going to the grocery store a week ago, I decided I didn’t want to be around many people. I started to see an increase [in my blood sugar] the second week of quarantine. The lack of my usual exercise routine and the abundance of food in the house contributes to that. I know this is partly due to environmental stress, but this is a lot to deal with at once.” 

Fortunately, the push for telehealth may yield its benefits for those who need to seek care without leaving their homes. Brown-Riggs suggests inquiring about telehealth with healthcare professionals.

“During this COVID-19 pandemic, it’s extremely important for African Americans and other minorities with diabetes to stay in contact with their diabetes treatment team. Under the recently enacted Coronavirus Preparedness and Response Supplemental Appropriations Act, physicians, nurse practitioner (NPs), physician assistants (PAs), nurse-midwives, clinical nurse specialists (CNSs), and registered dietitians (RDs) or nutrition professionals (RDNs) are permitted to provide telehealth services,” said Brown-Riggs.

She also emphasizes that it’s important to continue with regular self-care behaviors such as eating healthy, being active, and getting regular sleep. For people who are food insecure, check out local food assistance programs and banks. Brown-Riggs warns against scams and misinformation from people looking to capitalize on those most vulnerable to COVID-19.

There are other steps being taken to address this issue from an institutional level. Chicago Mayor Lori Lightfoot said in a news conference that an urgent public-health education and outreach campaign will be launched in minority neighborhoods worst-impacted by the coronavirus.

In early April, California released partial race-based data that did not show a disproportionate impact of COVID-19 on racial minorities — but the bottom line is that we need more data. “Based upon the 37% of the data that’s in, we are not seeing [race and ethnic disparities],” said California Governor Gavin Newsom. “But I caution you, the data is limited. Nothing is more frustrating than the disparities that manifest in relationship to public health. Those issues preceded this crisis and they persist in this crisis.”

The coronavirus crisis is a global pandemic, but its impact will follow the same patterns of health inequality built into systems, institutions, and culture. It’s important to remember that minority communities are already facing disproportionate impacts of COVID-19, with additional barriers to the resources and care needed to mitigate damage caused by the virus.

Source: diabetesdaily.com

Big Changes! Centers for Medicare & Medicaid Services (CMS) Loosen Requirements for Obtaining a Continuous Glucose Monitor (CGM) During COVID-19

This content originally appeared on diaTribe. Republished with permission.

By Karena Yan and Kelly Close

In-person visits, lab tests, and finger stick documentation are no longer required at present to get a CGM

Editor’s note: This article was updated on May 21, 2020 to reflect that lab testing is still required for an insulin pump and pump supplies.

High blood sugar levels leave the body vulnerable to infections, meaning those individuals with poorly controlled diabetes are at greater risk of contracting COVID-19. To properly monitor and respond to glucose levels and to strengthen the immune system to fight off infections, a continuous glucose monitor (CGM) can be very helpful.

If you are on Medicare, obtaining a CGM through your healthcare professional is a relatively involved process, requiring an in-person clinic visit, lab tests, documentation of frequent finger sticks (four or more times a day), and a lot of paperwork. At present, only those on insulin have an opportunity for approval. However, due to COVID-19 and the increased risks it poses for people with diabetes, the Centers for Medicare & Medicaid Services (CMS) announced that it will not enforce the following criteria for receiving a CGM:

  • In-person clinic visits
  • “Clinical criteria,” including lab tests for C-peptide or auto-antibodies, or demonstration of frequent finger sticks

This means that people with diabetes do not have to go to the doctor’s office or undergo lab tests to receive a CGM. Importantly, these loosened restrictions also reduce the amount of paperwork and bureaucracy for healthcare providers and give them greater flexibility in providing CGMs. Lab testing is still required for insulin pumps and pump supplies.

This increased access to CGMs is a huge win for the many people with diabetes on insulin who would not otherwise be able to get a CGM. Because CGMs provide real-time data for blood sugar levels, users are able to monitor their glucose and proactively adjust their insulin doses. Not only do CGMs help increase time in range, and thus have the opportunity to increase productivity and quality of life, but they can also improve overall diabetes management and can help keep patients out of the hospital.

We hope that in the future, at least those on SFUs will be able to get CGM, as SFUs can prompt hypoglycemia, which is especially dangerous right now, given the importance of staying out of the hospital.

Every person with diabetes can benefit from either a professional CGM used regularly (at least yearly) or a 24/7 CGM. While these new CMS guidelines are temporary in response to COVID-19, we are hoping and advocating for making the changes permanent. With the rise of the Beyond A1C movement and increased awareness of time in range, CGM (24/7 or professional) is an essential tool for people with diabetes to live happy and healthy lives, both during and after COVID-19.

This article is part of a series on time in range maybe possible by support from the Time in Range Coalition. The diaTribe Foundation retains strict editorial independence for all content.

Source: diabetesdaily.com

Melted Enlightened Keto Peanut Butter Cookies

I don’t know about you, but this quarantine has put me in the mood to bake all the time. Yet my inability to go to a store has pushed my creativity to the max by forcing me to make do with the ingredients I have on hand. Thankfully my pantry was well-stocked before the rush, but it’s the fresh ingredients that I’m not always able to get right now.

I wanted heavy whipping cream to create a peanut butter cookie recipe, but I didn’t have any. As I was searching around my freezer to see if I had anything good to eat, I found a hidden pint of Peanut Butter Fudge ice cream from Enlightened’s Keto Collection, and I decided it would make do as my heavy whipping cream.

Well, I’m pleased to report, it did more than ‘make do,’ and I won’t be using heavy whipping cream in this recipe once this is all over. The ice cream gave the cookies an extra rich, peanut buttery flavor. And of course I adjusted ingredient quantities to ensure I had enough ice cream leftover to make an ice cream sandwich.

Melted Enlightened Keto Peanut Butter Cookies

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Melted Enlightened Keto Peanut Butter Cookies

.wprm-recipe-rating .wprm-rating-star.wprm-rating-star-full svg * { fill: #343434; }

Instead of heavy whipping cream, a peanut butter fudge keto ice cream was used for this delicious treat.
Course Breads and Baked Goods, Snack
Cuisine American
Keyword low carb cookies
Prep Time 20 minutes
Cook Time 20 minutes
Total Time 40 minutes
Servings 18 cookies
Calories 137kcal

Ingredients

  • 1 cup Enlightened Peanut Butter Fudge Keto ice cream melted
  • 1 cup creamy peanut butter room temperature (the only ingredients should be salt and peanuts; if yours is just peanuts, add 1/4 tsp salt to the recipe)
  • 1/3 cup almond flour
  • 1/3 cup coconut flour
  • 1 large egg
  • 1 tsp vanilla
  • 1/2 cup Swerve (plus extra Swerve to roll in – optional)

Instructions

  • Pre-heat oven to 350 degrees.
  • Mix together the melted ice cream, peanut butter, almond flour, coconut flour, egg, vanilla and Swerve. Stir until a dough forms.
  • Roll dough into balls. (It can help to have some coconut oil on your fingers.)
  • If you want to, roll the balls in sweetener in a shallow bowl. (This will give them a crispier texture on the outside of the cookies and add some sweetness).
  • Line the balls on a parchment-covered cookie sheet.
  • Use a fork to make indents in the cookies. While doing this, ensure you’re flattening them, as this will pretty much be their final shape.
  • Bake for 17 minutes, or until done.
  • Remove from oven, and allow to cool fully.

Nutrition

Calories: 137kcal | Carbohydrates: 4g | Protein: 5g | Fat: 11g | Saturated Fat: 2g | Polyunsaturated Fat: 2g | Monounsaturated Fat: 4g | Cholesterol: 20mg | Sodium: 56mg | Potassium: 4mg | Fiber: 2g | Sugar: 1g


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Melted Enlightened Keto Peanut Butter Cookies Recipe

Source: diabetesdaily.com

Build Your COVID-19 Diabetes Go Bag

This content originally appeared on Beyond Type 1. Republished with permission.

By Jordan Dakin

When it comes to being hospitalized in the midst of the COVID-19 pandemic, it’s natural to worry about that possibility and while we hope we can stay home at all costs, being prepared for any scenario is the best course of action. As a result, packing a go bag in the case of a hospital visit during this time is crucial.

Most important? Pack your bag with 15 days of supplies to be on the safe side. The CDC recommends up to 14 days of quarantine in some cases for those who have been exposed or infected depending on the time it takes for symptoms to develop, so being prepared for a lengthy hospital stay just in case is advised.

The nature of COVID-19 is tricky because it requires isolation and even if you’re hospitalized for something diabetes-related, you run the risk of being exposed to COVID-19 in a hospital setting. Make sure you have all you need as it will be difficult for loved ones to get items to you if you are in isolation during a hospital stay.

Antiemetic or Anti-Nausea Medication

Zofran or any other antiemetic medicine is helpful to have on hand in case you do contract a mild form of COVID-19 to keep yourself from throwing up, as this can be dangerous and lead to DKA (diabetic ketoacidosis).

Carbs and/or Glucose Tabs

This may seem obvious, but it is so important. Be sure to pack some hard candy, fruit snacks, fruit juice, glucose tabs and gels, and any other preferred fast-acting carbohydrates.

Beverage(s) to Prevent Dehydration

This could include sports drinks, water, or a mix-in hydration powder with little to no carbs.

Ketone Strips and Glucagon

If you are sick, BGs are harder to manage and DKA can be a dangerous reality if you’re needing more insulin than normal while having trouble keeping carbs or fluids down. As a result, you should test for ketones more frequently when you are sick.

Insulin, Syringes, Pen Needles and Pump Supplies

Having backup methods to administer insulin is important in the event of a pump malfunction.

Testing Supplies Like a Blood Glucose Meter, Lancing Device, Lancet and Test Strips, Plus Sensors If Using Continuous Glucose Monitoring (CGM)

In some hospitals, it’s been difficult for patients to have their glucose levels checked hourly because healthcare workers don’t have enough personal protective equipment (masks, gloves, etc) to go in and out of patient rooms that often. Because of this, people with diabetes should be prepared to do their own testing and monitoring of blood glucose (BG). Bringing a backup method for testing aside from your CGM is also recommended in case sensors fail or other malfunctions occur.

Alcohol Swabs, Hand Sanitizer, Bandaids and Medical Tape

Disinfecting and keeping things clean and protected during this time is especially important.

Any Necessary Medications and Other Important Medical Details

This includes an itemized list of medications you’re currently taking, allergies to medications you might have, your physician’s information and emergency contact information.

Personal Protective Equipment

Pack your own gloves and masks or face coverings just in case. If possible, it might also be good to remember to wear PPE when entering the hospital to prevent excessive exposure to COVID-19.

Other Necessary Electronics and Chargers

Be prepared and bring any necessary cables to keep phones and tablets charged, especially if you’re using any kind of smart device to help monitor BGs.

A hospital stay during this time might sound scary, but it is important to take care of yourself and be prepared. If you are sick and have gone into DKA as a result and can’t keep down fluids, hospitalization becomes necessary and waiting only makes DKA more severe and life-threatening.

Source: diabetesdaily.com

Your Eye Health During COVID-19 — What You Should Know

This content originally appeared on diaTribe. Republished with permission.

By Kira Wang

While the global pandemic has interrupted many healthcare services, eye care is still essential and available under certain circumstances

Diabetes can lead to changes or problems in your vision, making annual eye appointments a necessity for every person with diabetes. One can prevent complications with vision for many years, even many decades, with some luck – it’s about glucose management as well as genes. For people who already have eye complications, treatment may be required as often as every few months in order to keep eyesight as strong as possible. But COVID-19 has disrupted many aspects of our daily lives, including the ability to visit eye care professionals for regular appointments. Although providers may not be able to see you in person at this time, there are still ways for you to access the care you need and keep your eyes as healthy as possible.

Can I still see my eye care provider in person?

We reached out to diaTribe’s network of healthcare professionals and learned that eye care providers are still treating emergencies and people with advanced cases of diabetes-related retinopathy and diabetes-related macular edema. Emergencies might include cases of trauma, infection, or sudden changes in vision (e.g., flashing lights, floaters, blurriness) – if you have experienced any of these situations, talk to your healthcare team right away.

If you have been diagnosed with diabetes-related retinopathy or diabetes-related macular edema, delaying treatment can risk worsening vision, and you may need to receive in-person care. If your treatment has been rescheduled, double-check with your healthcare team to make sure your vision is not at risk. For more mild cases of diabetes-related retinopathy or diabetes-related macular edema, your healthcare professional may consider the risks of exposure to COVID-19 versus how your vision will be affected without scheduled treatment.

Planning ahead is important, and every person is different – ask your doctor in advance about what specific plan works for you. If you do visit your eye care provider in person, remember to wear a face covering—this will help keep you and your healthcare team safe!

Telemedicine and eye care: when can I talk to my healthcare professional virtually? 

For problems with the outside of your eye, video visits can help you connect with your provider right from your home. Issues outside your eye might include redness, discharge, or swollenness. Explaining your symptoms to your provider over video can help them determine whether you’ll need to be seen in person.

What should I know about scheduling eye appointments in the midst of COVID-19?

For those who already have regularly scheduled eye appointments, your check-ups may be delayed during these times. If your visit is delayed, you should still pay attention to any changes in your vision. You can do this by giving yourself an at-home eye test.  If you don’t already have annual visits with an eye care professional, try to set up an appointment as soon as eye care clinics are back up and running.

Remember: keeping your blood sugar levels in range is central to maintaining healthy eyes.

In these challenging times, we are impressed by the use of telemedicine, for eye care and beyond. For more information on telemedicine during COVID-19, check out these nine tips by longtime diaTribe advisor Dr. Francine Kaufman. To the many healthcare professionals out there, we are grateful for your service and support. Mark your calendars—July is Healthy Vision Month, and we’ll have more articles on eyes coming your way soon!

About Kira

Kira Wang graduated from Duke University summa cum laude with a degree in psychology and minors in biology and chemistry. She wrote a senior thesis on the transactional coping strategies of parents and youths with chronic illness and spent time researching eye imaging techniques in the Duke Eye Center.

Source: diabetesdaily.com

What to Do If You Need Insulin Right Now

This content originally appeared on Beyond Type 1. Republished with permission.

By Lala Jackson

What to Do If You Have No Insulin at All

Go to the emergency room. Under US law (The Emergency Medical Treatment and Active Labor Act), the emergency room cannot turn you down in a life-threatening emergency if you do not have insurance or the ability to pay.

If Emergency Room staff is telling you they cannot treat you, stay put. Be clear that you are in a life-threatening emergency because you have type 1 diabetes (T1D) but do not have insulin. Do not leave. Please note that urgent care centers are not required to abide by the same laws.

Once you are stabilized and before you leave the hospital, hospital staff is required to meet with you to make sure you understand that you are leaving the hospital of your own accord. At this time, let the hospital staff person know about any financial situation you are in. Some hospitals are aligned with charities that can help you pay. Other hospitals offer payment plans based on your situation. No matter your financial situation, know that your life is the most important thing.

What to Do If You Have Some Insulin, But Are About to Run Out

Utilize Kevin’s Law

If you have an existing prescription at your pharmacy, but have not been able to get ahold of your healthcare provider to renew the prescription, you may be able to take advantage of Kevin’s Law. Kevin’s Law was named for a man with T1D who passed away after not being able to access his insulin prescription over the New Year’s holiday. Under the law, pharmacists are able to provide an emergency refill of insulin in certain states, without the authorization of a physician to renew the prescription. Rules around the law vary from state to state and not all states have the law in place. Kevin’s Law only applies to those who have an existing prescription and, depending on where you live, your insurance may or may not cover the refill. Learn more about Kevin’s Law, including whether or not your state has it, here. Please note, your pharmacist may not know the law by name, or know that the law exists. If you are in a state with Kevin’s Law and working with a pharmacist who is unaware, stay put and ask to speak to someone else in the pharmacy.

Ask Your Physician for Samples

While this is not a long-term access option, your care provider may be able to provide you with a few vials/pens for free, and bringing your HCP into the access conversation means that they can help direct you to other options that might be available to you, like local community health centers with insulin available.

Utilize Patient Assistance Programs – Standard out of Pocket Cost $0

  • If you take Lilly insulin (Humalog, Basaglar) call the Lilly Diabetes Solutions Call Center Helpline at 1-833-808-1234
    for personalized assistance. You may be eligible for free insulin through LillyCares.
  • If you take Novo Nordisk insulin (Fiasp, NovoLog, NovoRapid, Levemir, Tresiba) and demonstrate immediate need or risk of rationing, you can receive a free, one-time, immediate supply of up to three vials or two packs of pens by calling 844-NOVO4ME (844-668-6463) or by visiting NovoCare.com
  • If you take Sanofi insulin (Admelog, Lantus, Toujeo): the Patient Connection Program provides Sanofi insulins to those who qualify, which is limited to those with no private insurance and who do not qualify for federal insurance programs and who are at or below 250% of the federal poverty level – with a few exceptions.

Utilize CoPay Cards – Standard out of Pocket Cost $35 – $99 per Month

Copay cards that reduce the out-of-pocket cost you pay at the pharmacy exist for most types of insulin. Some copay cards can be emailed to you within 24 hours. Currently, copay programs exist for:

  • Lilly, capping copays at $35 per month for those with no insurance or with commercial insurance
  • Novo Nordisk, capping copays at $99 for those with no insurance or with commercial insurance
  • Sanofi, capping copays at $99 for those without prescription medication insurance
  • Mannkind, capping copays at $15 for some of those with commercial insurance

Unfortunately, copay cards are typically not available for those insured through Medicaid or Medicare. Use the tool from the Partnership for Prescription Assistance to search in one place for discount programs and copay cards you qualify for here. Please be aware that you will need to search by brand name (i.e. Humalog, Novolog), not just “insulin.”

Get R & NPH Human Insulins – Standard out of Pocket Cost $25-$40 per Vial

R (Regular) and N (NPH) human insulins are available over-the-counter in 49 states and cost much less ($25-$40 per vial at Walmart) than analog insulins such Novolog, Humalog, Lantus, or Basaglar. They also work differently than analog insulins – they start working and peak at different times – but in an emergency situation can be a resource. Speak with the pharmacist or your healthcare provider if possible before changing your regimen and keep a very close eye on your blood sugar levels while using R & N insulin.

Research Available Biosimilar (Generic) Insulins

The biosimilar insulin market is changing rapidly as the FDA adopts new regulatory pathways to more efficiently approve interchangeable insulins that may be available for a lower price. Ask your healthcare provider for the most up-to-date options for you. A few options available are:

  • A generic version of Humalog — Insulin Lispro — is available at pharmacies in the U.S. for $137.35 per vial and $265.20 for a package of five KwikPens (50% the price of Humalog.) If you have a prescription for Humalog, you do not need an additional prescription for Lispro; your pharmacist will be able to substitute the cheaper option. Insulin Lispro is not currently covered by insurance.
  • Authorized generic versions of NovoLog and NovoLog Mix at 50% list price are stocked at the wholesaler level. People can order them at the pharmacy and they’ll be available for pick up in 1-3 business days

If you have enough insulin to last you a few days, but need to figure out where to get a more reliable, consistent supply, visit our Get Insulin page to find further resources.

Source: diabetesdaily.com

Emergency Changes to SNAP and WIC (Food Stamps) Adjust to Thousands of New Applicants During COVID-19

This content originally appeared on diaTribe. Republished with permission.

By Karena Yan

SNAP and WIC help connect millions of individuals and families to affordable, nutritious foods. Here are how these programs are evolving

Healthy food and nutrition are important not only for managing diabetes but also for the proper function of your immune system. The World Health Organization (WHO) recommends that people maintain a nutritious diet and limit their alcohol and sugary drink consumption to improve our bodies’ ability to fight off viruses like COVID-19.

At the Tufts’ Food and Nutrition Innovation Council (FNIC) Summit on April 16, experts in nutrition, healthcare, and policy gathered to discuss the implications of coronavirus on the affordability, accessibility, and sustainability of healthy food in our country. In addition to discussing the changes brought about by the pandemic, council members made food policy recommendations for the post-COVID future.

While coronavirus poses a challenge for the smooth operation of programs like the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the USDA’S Food and Nutrition Service has implemented emergency changes to these programs to ensure access to healthy food for program recipients.

What are SNAP and WIC?

SNAP, previously referred to as food stamps, is a federal program that provides nutrition benefits for eligible, low-income individuals and families to support their ability to purchase healthy foods. These benefits are provided via an Electronic Benefits Transfer (EBT) card, which acts as a debit card at authorized retail food stores.

Similarly, WIC provides federal grants to low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. WIC serves about half of all infants in the United States, and these grants supplement the purchase of foods, health care referrals, and nutrition education.

How has coronavirus impacted SNAP and WIC?

As unemployment has reached nearly unprecedented levels , enrollment for SNAP and WIC has seen a marked increase. In California, application volume to receive CalFresh, the state’s version of SNAP, has seen a 350 percent increase since the crisis began. More than 57 percent of these applicants reported that they lost a job within the previous 30 days, compared to 16 percent in January.

Graphs

Image source: diaTribe

Moreover, panic buying and stockpiling during the epidemic have made the availability of SNAP- and WIC-eligible products scarcer. This is particularly true for WIC recipients, who may only use their funds on a limited list of products that have been selected as low-cost and nutritious. For those who do not receive WIC benefits, the National WIC Association asks shoppers that if they are choosing between two items, one of which is WIC-eligible, to avoid buying or hoarding WIC-eligible products, including infant formula.

What emergency changes have been implemented to support SNAP and WIC?

The USDA has implemented a 40 percent increase in overall SNAP benefits, which amounts to a $2 billion monthly allotment in addition to the usual $4.5 billion that goes toward monthly SNAP benefits. WIC has also received $500 million in additional funding to cover increases in program participation.

Additionally, while SNAP and WIC have some requirements that are challenging to meet during COVID-19, such as mandatory in-person visits to enroll or re-enroll in the programs, the USDA has offered many accommodations to these requirements. However, the USDA’s Food and Nutrition Service has offered many accommodations to these requirements, in addition to providing extra funding to both programs. Several of these program changes are highlighted below. To see the full list of changes, please see here.

SNAP:

  • Application Processing: State agencies can extend certification periods and temporarily waive periodic report form submissions for enrolled households. Additionally, in lieu of face-to-face interviews for enrollment, states are waiving the interview requirement or conducting interviews via telephone.
  • Pandemic EBT (P-EBT): States are now allowed to provide benefits (similar to SNAP or “food stamps”) to children who normally receive free or reduced-price school meals.
  • Able-bodied Adults without Dependents (ABAWDs) Time Limit Suspension: States may temporarily suspend the time limit associated with ABAWD work requirements, which ordinarily terminate an ABAWD’s SNAP benefits after three months of unemployment.

WIC:

What happens after COVID-19 is over?

At the Tufts’ FNIC Summit, council members discussed the importance of maintaining some, or all, of these measures after the crisis. Requirements such as in-person visits and lengthy renewal processes pose barriers for SNAP/WIC recipients and risk delaying or inhibiting people’s ability to access these services, regardless of the circumstances. Moreover, given the sharp uptick in SNAP/WIC enrollments, the increased efficiency and accessibility of these programs will greatly benefit recipients long after the “end” of the coronavirus crisis.

Furthermore, council members hope even further adjustments to SNAP/WIC are made in the future. While these programs have been relatively effective in facilitating access to healthy foods for low-income individuals and families, the FNIC calls for greater emphasis on nutrition within the programs, such as by providing a subsidy for fruit and vegetable purchases or removing sugar-sweetened beverages from the list of eligible purchases.

Such incentives can provide vast benefits for both individual health and healthcare costs. For example, a 30 percent fruit and vegetable incentive for SNAP participants is estimated to save $6.77 billion in healthcare costs over a lifetime. Thus, while some headway has been made to these SNAP/WIC programs, advocates must pursue not only the permanence of these adjustments but also additional changes to the programs’ health and nutrition standards and practices.

Source: diabetesdaily.com

Chestnut Crepes with Walnuts & Cheddar

This content originally appeared on ForGoodMeasure. Republished with permission.

Chestnut flour is a hallmark of Tuscany’s culinary heritage. The nutrient-rich chestnut wrapped in it’s spiky jacket has been a dietary staple since medieval times. Naturally sweet, the flour lends itself as an excellent base for pancakes. Called Necci in Italian, chestnut flour crepes pair excellently with sharp cheddar and toasted walnuts for a decadent, flavorful breakfast or alongside a crisp salad or bowl of soup.

Photo credit: Jennifer Shun

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Chestnut Crepes with Walnuts & Cheddar

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Pair this chestnut crepe with sharp cheddar and toasted walnuts for a decadent, flavorful breakfast or serve it alongside a crisp salad or bowl of soup.
Course Breakfast, Snack
Cuisine Italian
Keyword chestnut, crepe
Prep Time 10 minutes
Cook Time 20 minutes
Total Time 30 minutes
Servings 8
Calories 227kcal

Ingredients

  • 3 eggs
  • 1 cup water
  • ½ cup chestnut flour
  • 2 tablespoons butter divided
  • 1 cup cheddar cheese shredded
  • 1 cup walnuts toasted*

Instructions

  • Whisk eggs, water and chestnut flour until smooth.
  • Rest for 10 minutes.
  • Heat a small non-stick skillet on medium.
  • Working in batches, melt ¼ tablespoon of butter in pan.
  • Pour ¼ cup of batter into pan, tilting to coat the bottom evenly.
  • Cook until crepe lifts easily from bottom of pan, about 2 minutes.
  • Using a spatula, flip to cook the reverse side.
  • Add 2 tablespoons of cheese & walnuts, folding the crepe in half to melt.
  • Repeat with remaining batter.

Notes

Naturally low-carb & gluten-free

* To toast walnuts, heat a non-stick skillet on medium-high. Add walnuts in a single layer. Cook for 5 minutes, stirring frequently. Remove from pan to cool.

Nutrition

Calories: 227kcal | Carbohydrates: 12g | Protein: 7g | Fat: 17g | Cholesterol: 74mg | Sodium: 126mg | Fiber: 2g | Sugar: 3g


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Chestnut Crepes with Walnuts & Cheddar Recipe

Source: diabetesdaily.com

Embracing Community in Times of Crisis

This content originally appeared on Beyond Type 1. Republished with permission.

By Erin McShay

Sometimes in life, it takes something bad to happen for us to pause and appreciate how good things once were. I used to think of our lives as before and after our Sam was diagnosed with type 1 diabetes. Fast forward twelve years: he’s a senior in high school and the Corona virus is sweeping the country. The cacophony of chaos in the world is now pulling our attention into dark territory, channeling voices of fear and uncertainty. It’s almost as if time has slowed down to a crawling pace; giving us the chance to inhale and catch our second wind.

Community

Image source: Beyond Type 1

Always a Battle

Dealing with any chronic illness is an arduous job packed with hundreds of additional decisions to make a day. Ordering supplies, planning and packing become essential, life-saving chores. We take the burden in stride, but then become our harshest critic when thing go wrong. From personal experiences, I’ve learned that dwelling on our missteps serves no one. Remember that Billy Joel song? “We’re only human, we’re supposed to make mistakes.”

Just last year I made a doozy when we sent our two teenagers to Houston to visit family – I forgot to pack additional insulin pump cartridges for our son. Halfway into the trip, Sam called to say he ran out of cartridges. We’ve taken dozens of trips throughout the years, driven and flown across the country, camped in remote areas, and I’ve never forgotten anything. I told him to check again. We went over the list together; extra insulin, needles, blood sugar meter, back up meters, test strips, infusion sets, ketone strips but no cartridges. In a cupboard, I found the sandwich baggie of them that somehow got left behind. Anyone who’s ordered these types of supplies knows that you can’t just walk into a pharmacy to get more; in fact, you only have a few options and they all take twenty-four hours to ship. It didn’t matter how many times my son and husband told me it was okay: two thousand miles away, I spent the entire night consumed with guilt and worry, crying on my husband’s shoulder. Sam spent the night waking up every two hours to do blood sugar checks and give himself shots. He learned a hard lesson and so did I, but meanwhile we still had to find cartridges.

Community

Image source: Beyond Type 1

Somehow, on a hunch and a prayer I managed to look up a Facebook/Beyond Type 1 friend whom I’ve never met – and asked for help. It was a miracle really. I was a complete stranger to her, she could have said, ‘Sorry,’ but instead this angel went to extraordinary measures for us by reaching out to her community to find me the specific cartridges I needed for Sam’s pump. Her son had a different pump, but a friend of her’s (another angel) met Sam and my sister-in-law to give them an exceeding amount, beyond what he needed. I paid her back when I got her address, but at the time I don’t think they knew the depth of my gratitude. Not to mention the many thanks to my sister-in-law for driving Sam to another county, and our family in Houston for taking such good care of him.

When You Need Help, Ask

The chances are in your favor in the type 1 community with a million out-stretched hands, and general well-wishers ready and willing to offer not only advice, but whatever you need to help you get by.

I’m embarrassed to say I ran out of supplies once before the Houston trip. Not long after Sam was diagnosed, we depleted our infusion sets before our new order arrived. Luckily a neighbor, whom I met through a friend, had the same insulin pump as Sam, and gave us a few loaners. Another neighbor, a type 1 diabetes (T1D) dad who lived around the corner from us, went out of his way to offer advice and help us when Sam was first diagnosed. We were so scared in those early years and his helpful words still bring me comfort years later.

Get to Know Your Neighbors

Once, I bonded with a fellow writer at a conference, where I divulged that I had a son with type 1 diabetes. We became fast friends after she told me she had developed late adult onset T1D. One night, when my son’s pump stopped working, I called her in tears. My husband was out of town and I couldn’t get Sam’s pump to prime. She drove over to my house at ten at night – because these problems never happen in the middle of the day – and got the pump working again.

I wouldn’t have known these angels to receive help from them, had I not been as forthcoming about Sam’s disease. Nor would I have met them if I wasn’t on Facebook or involved with my community. You don’t realize these tiny miracles for what they are, until after the fact. If not for their help, I would probably be in a strait-jacket staring at a cement wall somewhere. Instead, I am now willing and able to pay it forward anyway I can.

Sibling

Image source: Beyond Type 1

As a writer and avid reader, I peruse tons of articles and social media sites a day, and if there is one thing I’ve learned, it’s to think before you say or post something. Negativity helps no one. I’ve found that depressing, bleak posts can linger in your psyche long after you’ve read them. Your views can really impact others. On the other hand, knowing how meaningful certain tweets can be, spreading love and encouragement, cannot only change a person’s day but has the power to alter their lives.

One kind word can mean the world to someone. Life is hard, especially with a chronic illness and there is no question diabetes stinks, but what a wonderful support system we have in place within the T1D community! People can be quite beautiful, and they have a wealth of knowledge on a much deeper level sometimes than our medical professionals.

Pay It Forward

I heard once that Jackie Kennedy Onassis said that motherhood was the most important job on earth and if you mess that up, whatever else you do doesn’t matter very much. My son and daughter are edging their way to adulthood now, and I hope that they’ve learned from my mistakes and watched how I forgive myself. I hope they’ve learned from the tiny mercies shown to us, and that when someone’s in need, you offer a helping hand or an encouraging word without blinking. I hope they stand up to injustice when they see it, and become advocates for the less fortunate, like those struggling to afford insulin.

As I reflect in this trying time, I see that through Sam’s diagnosis, we’ve learned and grown so much because of it. It’s made us who we are – all of us. And though this is a flawed, imperfect world, we truly have a family beyond our own. No amount of social distancing can diminish how interconnected we truly are. The silver lining through this all is that we have each other.

Source: diabetesdaily.com

Working with Your Healthcare Team to Achieve Your Time in Range Goals: An Interview with Cleveland Clinic’s Dr. Diana Isaacs

This content originally appeared on diaTribe. Republished with permission.

By Frida Velcani

Dr. Diana Isaacs on improving time in range, making the most of your data, and the barriers facing people with diabetes and their healthcare teams

Dr. Diana Isaacs is a Clinical Pharmacist and Diabetes Care and Education Specialist at the Cleveland Clinic. She works with people with diabetes on a range of issues, including medications, technology, and lifestyle changes. She also educates people every day about the benefits of time in range.

In addition, Dr. Isaacs is the coordinator for the Cleveland Clinic’s continuous glucose monitor (CGM) program. You can find more information on how to choose a CGM here. We continue to think that CGM is of the utmost importance for helping people keep their blood glucose levels in-range, assuming they have access. Dr. Isaacs meets with 200 people every month, through individual appointments, classes, phone follow-ups, and virtual visits. She also works with other healthcare providers, including nurses, nurse practitioners, dietitians, and physicians.

For this article, we spoke with her to better understand her views on the importance of time in range for people with diabetes. Here are her insights on how we can shift away from using A1C and move everyone toward better health.

Dr. Isaacs on Ways to Improve Time in Range, Setting Target Goals, and Celebrating the “Wins” 

We asked Dr. Isaacs to pinpoint the most important things that people can do to improve their time in range. “Work with your diabetes care and education specialist and healthcare team to interpret CGM data, understand patterns, and optimize medication doses,” she said. When reviewing data, it’s important to keep a positive attitude and focus on the successes. Repeat what worked well on the days when your time in range was the highest. Figure out what is causing the lows (which often lead to rebound highs) and work to prevent them.

Dr. Isaacs wants people to know that having high glucose variability is completely normal. Many people have the misconception that they should be spending 100% time in range. In reality, time-in-range goals are different for each individual depending on factors such as medication, age, and type of diabetes. Experts recommend that people with type 1 and type 2 diabetes aim to spend at least 70% of the day within 70 to 180 mg/dl, less than 4% of the day below 70 mg/dl, and less than 25% above 180 mg/dl. However, experts emphasize that even a 5% change in time in range – for example, going from 60% to 65% – is meaningful, as that translates to one more hour per day spent in-range.

“I’ve seen everything from 0% to 100% time in range,” she said. “There are differences when comparing someone who is new to our clinic compared to someone working with us for a year. It’s so individualized, and people have different challenges. The goal is to improve your personal time in range, and any increase in time in range is a win.”

Measuring Time in Range using Blood Glucose Meters, CGM, and Professional CGM

If you are using a blood glucose meter (BGM) or CGM, talk with your healthcare team about your glucose targets. The data will be more meaningful if you are working toward a specific goal.

For BGM users, paired testing can help you see the direct impact of food on your blood glucose – all you have to do is check your glucose before a meal and again two hours after the meal. To check that your basal insulin is working well, check your glucose levels before bed and first thing in the morning.

At the Cleveland Clinic, people are required to attend a two-part shared appointment to get access to professional CGM. The classes are usually two diabetes care and education specialists (pharmacist and dietitian or nurse) and 4-6 people with diabetes.

In part one, you go over glucose targets, time in range, and how to treat high and low blood sugars. In part two, you download the data and review it with your diabetes care and education specialists. You discuss what it means, find patterns, and make medication adjustments as needed. This class is offered five times per month. Dr. Isaacs says that this program has helped many people improve their A1C (an average 0.8% reduction) and diabetes self-management.

How can we make time in range accessible to people with diabetes and their healthcare teams?

Dr. Isaacs believes that everyone should have access to affordable medications, affordable technology, and a great support system. She says, “I’ve seen so much rationing of insulin and medications, especially in the Medicare and uninsured populations.” There are many people that have diabetes and haven’t connected with their healthcare team in years. We need to do a better job to help these people.

According to Dr. Isaacs, the average healthcare professional is not prepared to talk about time in range. A1C has been and continues to be widely used by most healthcare teams. While she is excited about the growing use of CGM, there are “still some hurdles to get all practices up to speed with how to download the devices and interpret the data.”

Her advice is to tackle these barriers from multiple angles:

  • In research, we need to make sure that time in range is an outcome in all clinical trials that measure glycemic management, so that we can directly measure the effect of time in range on clinical outcomes.
  • We need targeted education for busy healthcare professionals, including podcasts, webinars, and continuing education.
  • We need targeted education for people with diabetes who are often the ones bringing information to their healthcare team.
  • In practice, healthcare professionals should discuss time in range with every person with diabetes that is using CGM.
  • People with diabetes using CGM should be encouraged to bring their reports to their healthcare provider and discuss time in range.
  • Instead of only marketing CGM as a convenient way to reduce finger sticks (which is true), the real benefit is that it lets the person with diabetes be the driver, and time in range is their roadmap.

Dr. Isaacs recently spoke on a panel at the ADA post-graduate sessions about the power of time in range and CGM for all people with diabetes. She was joined by diaTribe’s medical advisory board member, Dr. Irl Hirsch, our editor-in-chief, Kelly Close, and Jane Kadohiro as the moderator, who herself has had diabetes for over 50 years. If you or your healthcare provider are interested in learning more about time in range and downloading CGM data, you can make an account and watch the session here!

Source: diabetesdaily.com

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